Teaching in radical prostatectomy is safe: a multicenter prospective registry analysis.

To evaluate the impact of teaching during radical prostatectomy in a nationwide prospective registry, assessing whether teaching influences perioperative or pathological outcomes. Data were extracted from the Swiss Urology Prostatectomy Registry, a nationwide quality-monitoring program including all certified training centers. Teaching was defined as procedures performed by a supervised trainee as primary operator. Baseline and perioperative outcomes were compared descriptively, and multivariable regression models assessed associations between teaching status and perioperative and pathological outcomes. A total of 7,607 men underwent radical prostatectomy between 2020 and 2025, of whom 825 (10.8%) were teaching cases. In multivariable analyses, teaching operations were associated with a higher likelihood of any 30-day complication (OR 1.41; 95% CI 1.09–1.82; p = 0.008) and longer operative time, with an adjusted mean increase of 31 min (95% CI 26–37; p < 0.001). Teaching status was not associated with severe complications (Clavien–Dindo ≥ III; OR 0.62; 95% CI 0.24–1.36; p = 0.283), transfusion requirement (OR 1.56; 95% CI 0.36–4.60; p = 0.478), positive surgical margins (OR 0.99; 95% CI 0.81–1.22; p = 0.960), nerve-sparing (OR 1.12; 95% CI 0.90–1.39; p = 0.306), or lymph node yield (adjusted mean difference + 0.5 nodes; 95% CI − 0.3 to 1.4; p = 0.226). Teaching during radical prostatectomy is safe and does not compromise surgical or pathological outcomes. Although longer operative times were observed, supervised trainee involvement can be safely integrated into structured training programs.